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Objective  This study aimed to determine whether neonatal hyperbilirubinemia is associated with a risk of autism spectrum disorder (ASD) using a large population-based cohort. Study Design  This retrospective cohort study used data from the children's database (2000–2012) of the National Health Insurance Research Database (1996–2012) in Taiwan. We included neonates who were born between 2000 and 2004 and aged <1 month diagnosed with and without hyperbilirubinemia. The primary outcome was physician-diagnosed ASD. At the end of 2012, multivariate Cox's regression analysis was used to estimate hazard ratios (HRs). Results  A total of 67,017 neonates were included. The neonates with hyperbilirubinemia were associated with 1.28-fold increased risk of ASD (HR = 1.28, 95% confidence interval [CI]: 1.05–1.57) compared with those without hyperbilirubinemia. In subanalysis to determine how phototherapy and exchange transfusion treatment for hyperbilirubinemia were associated with ASD showed no association between treatment and ASD, suggesting the lack of a dose-response effect of hyperbilirubinemia on the risk of ASD. Boys had a nearly six-fold higher risk of ASD than girls (HR = 5.89, 95% CI: 4.41–7.86). Additionally, neonates born with preterm birth and low birth weight were associated with a risk of ASD (HR = 1.46, 95% CI: 1.00–2.13). Conclusion  We did not observe a dose-response effect of hyperbilirubinemia on ASD, but neonatal hyperbilirubinemia may be an independent risk factor for ASD if there is a residual confounding by other perinatal complications. Therefore, this study does not support a causal link between neonatal hyperbilirubinemia exposure and the risk of ASD. [ABSTRACT FROM AUTHOR]

Studies evaluating the risk of peripheral arterial disease (PAD) in patients with abdominal aortic aneurysm (AAA) are limited. We used insurance claims data of Taiwan to establish a cohort of 6590 patients with AAA newly diagnosed from 2000 to 2008 and 6590 controls without AAA matched by propensity score. The subsequent incidence density rates of PAD were estimated in both cohorts by the end of 2011, and the AAA cohort to the non-AAA cohort hazard ratios (HRs) of PAD were calculated using Cox proportional hazards models. The incidence density of PAD in the AAA cohort was 3.7-fold greater than that in the non-AAA cohort (14.1 vs 3.66 per 1000 person-years) with an adjusted HR of 3.56 (95% confidence interval [CI] = 2.89-4.39). For those without comorbidities, PAD in the AAA cohort was 7.4-fold greater than that in the non-AAA cohort (12.0 vs 1.61 per 1000 person-years) with an adjusted HR of 6.70 (95% CI = 4.43-10.1). The incidence of PAD in patients with ruptured AAA was lower than that in patients without rupture (6.95 vs 15.0 per 1000 person-years). This study demonstrates that patients with AAA are at increased risk of developing PAD. [ABSTRACT FROM AUTHOR]

Objective: This population-based cohort study investigated the risk of developing peripheral arterial occlusive disease (PAOD) in patients with Bell’s palsy. Methods: We used longitudinal claims data of health insurance of Taiwan to identify 5,152 patients with Bell’s palsy newly diagnosed in 2000–2010 and a control cohort of 20,608 patients without Bell’s palsy matched by propensity score. Incidence and hazard ratio (HR) of PAOD were assessed by the end of 2013. Results: The incidence of PAOD was approximately 1.5 times greater in the Bell’s palsy group than in the non-Bell’s palsy controls (7.75 vs. 4.99 per 1000 person-years). The Cox proportional hazards regression analysis measured adjusted HR was 1.54 (95% confidence interval (CI) = 1.35–1.76) for the Bell’s palsy group compared to the non-Bell’s palsy group, after adjusting for sex, age, occupation, income and comorbidities. Men were at higher risk of PAOD than women in the Bell’s palsy group, but not in the controls. The incidence of PAOD increased with age in both groups, but the Bell’s palsy group to control group HR of PAOD decreased as age increased. The systemic steroid treatment reduced 13% of PAOD hazard for Bell’s palsy patients, compared to those without the treatment, but not significant. Conclusions: Bell’s palsy appears to be associated with an increased risk of developing PAOD. Further pathophysiologic, histopathology and immunologic research is required to explore the underlying biologic mechanism. [ABSTRACT FROM AUTHOR]

Background: The etiology of herniated intervertebral disc (HIVD) disease in children and adolescents is multifactorial and not merely related to disc degeneration. Therefore, in the present study, we investigated the relationship between young asthma patients and the risk of early HIVD disease in a population under 30 years of age.Methods: Data from the National Health Insurance Research Database (NHIRD) of Taiwan were used to conduct a retrospective longitudinal cohort study. The study cohort comprised 23,470 patients with asthma (asthma group) and 23,470 patients without asthma (non-asthma group), who were selected through frequency matching on the basis of sex, age, and the index year. The study patients were followed until HIVD disease occurrence, withdrawal from the National Health Insurance program, or 31 December 2013. Cox proportional hazards regression analysis was conducted to assess the risk of HIVD disease in the asthma group after adjustment for sex, age, and comorbidities.Results: After adjustment for sex, age, and comorbidities, the asthma group had a 1.69-fold (95% confidence interval [CI] = 1.29-2.23) higher risk of HIVD disease than did the non-asthma group. In addition, the asthma group had a higher risk of cervical and lumbar HIVD diseases than did the non-asthma group (adjusted hazard ratio [HR] = 2.38; 95% CI = 1.25-4.57 and adjusted HR = 1.56; 95% CI = 1.15-2.12, respectively).Conclusions: Young patients with asthma are at a significantly higher risk of early cervical or lumbar HIVD disease. [ABSTRACT FROM AUTHOR]

The prevalence of myopia has rapidly increased in recent decades and has led to a considerable global public health concern. In this study, we elucidate the relationship between Kawasaki disease (KD) and the incidence of myopia. We used Taiwan’s National Health Insurance Research Database to conduct a population-based cohort study. We identified patients diagnosed with KD and individuals without KD who were selected by frequency matched based on sex, age, and the index year. The Cox proportional hazards regression model was used to estimate the hazard ratio and 95% confidence intervals for the comparison of the 2 cohorts. The log-rank test was used to test the incidence of myopia in the 2 cohorts. A total of 532 patients were included in the KD cohort and 2128 in the non-KD cohort. The risk of myopia (hazard ratio, 1.31; 95% confidence interval, 1.08–1.58; P<0.01) was higher among patients with KD than among those in the non-KD cohort. The Cox proportional hazards regression model showed that irrespective of age, gender, and urbanization, Kawasaki disease was an independent risk factor for myopia. Patients with Kawasaki disease exhibited a substantially higher risk for developing myopia. [ABSTRACT FROM AUTHOR]

In Oriental countries, combinations of Chinese herbal products (CHPs) are often utilized as therapeutic agents for chronic obstructive pulmonary disease (COPD). The effects of CHPs on COPD have been previously reported. This study aimed to analyze the frequency of prescription and usage of CHPs in patients with COPD in Taiwan. In this nationwide population-based cross-sectional study, 19,142 patients from a random sample of one million individuals in the Longitudinal Health Insurance Database 2000 (LHID 2000) of the National Health Insurance Research Database (NHIRD) were enrolled from 2000 to 2011. The multiple logistic regression method was used to evaluate the adjusted odds ratios for the utilization of CHPs. For patients with COPD, there was an average of 6.31 CHPs in a single prescription. The most frequently prescribed CHP for COPD was Xiao-Qing-Long-Tang (XQLT) (2.6%), and the most commonly used combination of two formula CHPs was XQLT with Ma-Xing-Gan-Shi-Tang (MXGST) (1.28%). The most commonly used single CHP for COPD was Bulbus Fritillariae (3.65%), and the most commonly used combination of two single CHPs was Bulbus Fritillariae with Puerariae Lobatae (1.09%). These results provide information regarding personalized therapies and may promote further clinical experiments and pharmacologic research on the use of CHPs for the management of COPD. Furthermore, we found that TCM usage was more prevalent among men, younger, manual workers, residents of Northern Taiwan, and patients with chronic bronchitis and asthma. This information on the distribution of TCM usage around the country is valuable to public health policymakers and clinicians. [ABSTRACT FROM AUTHOR]

Leukemia is the most common malignancy among all childhood cancers and is associated with a low survival rate in adult patients. Since 1995, the National Health Insurance (NHI) program in Taiwan has been offering insurance coverage for Traditional Chinese Medicine (TCM), along with conventional Western medicine (WM). This study analyzes the status of TCM utilization in Taiwan, in both pediatric and adult patients with leukemia. A retrospective cohort study was conducted using population-based National Health Insurance Research Database of Registry of Catastrophic Illness, involving patient data from 2001 to 2010 and follow-up data through 2011. The effectiveness of TCM use was evaluated. Relevant sociodemographic data showed that both pediatric and adult patients who were TCM users one year prior to leukemia diagnosis were more likely to utilize TCM services for cancer therapy. A greater part of medical expenditure of TCM users was lower than that of TCM nonusers, except little discrepancy in drug fee of adult patients. The survival rate is also higher in TCM users. Altogether, these data show that TCM has the potential to serve as an adjuvant therapy when combined with conventional WM in the treatment of patients with leukemia. [ABSTRACT FROM AUTHOR]

Background: Colonic diverticular disease is a chronic gastrointestinal disorder. Previous studies have suggested that chronic gastrointestinal tract is involved in the pathophysiology of Parkinson's disease.Object: This study investigated the potential link between colonic diverticular disease and risk of Parkinson's disease.Methods: Data in this nationwide population-based cohort study were obtained from the National Health Insurance Research Database. Patients with colonic diverticular disease were identified from among 23.22 million insured Taiwanese residents who had been diagnosed between 2000 and 2005 and were aged ≥20 years (n = 23367). The comparison cohort included patients without colonic diverticular disease, matched by sex, age, and all comorbidities with the colonic diverticular disease patients cohort (n = 23367). Using univariable and multivariable Cox proportional hazard regression models, we estimated the adjusted hazard ratio (aHR) for PD with a 95% confidence interval (CI) after adjusting for age, sex, and all of comorbidities.Results: The risk of Parkinson's disease was higher in the CDD cohort than in the comparison cohort (HR = 1.27, 95%CI = 1.10-1.47). Compared with patients aged ≥65 years without CDD, the CDD patients in the equal age group had a 1.25-fold increased risk of PD (95% CI = 1.07-1.46).Conclusion: Colonic diverticular disease may be associated with an increased risk of Parkinson's disease. Thus, the risk of this neurodegenerative disease should be considered in patients with colonic diverticular disease. [ABSTRACT FROM AUTHOR]